Guidelines & Safety

Safety Training

Safety training is scheduled every four months.

Depending on number of registrants (min. of 5), next safety training will take place on Tuesday, December 3rd, from 8:00-13:00 at the control room.

Those planning to attend are requested to register.

Scanning people with tattoos

Scanning people with tattoos has been approved for ENU, under certain limitations:

  • People with permanent makeup, tattoos on the head, neck, or face, or people with large tattoos (over 10% of the skin) cannot be scanned.

Extra care should be taken when scanning people with tattoos:

  • The participant will declare the existence of a tattoo, its size, location on body, and the place of making the tattoos in writing as part of the metal questionnaire.
  • In addition to written information, the participant will report orally to the RT about any tattoos or permanent makeup. The location, size and color of the tattoo must be reported as well.
  • The participant will be given all information about the potential risks associated with scanning tattoos. This information will be given both orally and as part of the informed consent form that was approved by the Helsinki committee.
  • The participant will be instructed to immediately report any heat/pain or abnormal sensation in the area of the tattoo. The participant should explicitly be told that they should press the stress button (and thus stop the exam) at any time during the exam if they fell heat in the area of the tattoo.
  • Subjects with tattoo will be monitored closely, while maintaining auditory and/or visual contact throughout the exam.

Even when all limitation are followed, the radiology technician may decide not to scan a potential participant with a tattoo.

The inclusion of participants with tattoos in the research must be confirmed for each research protocol (Helsinki) separately, and be explicitly included in the informed consent form of that research!

For full details on when & how to scan people with tattoos as well as other safety issues, please refer to the ENU working guidelines & safety regulations (English version)

Adverse MRI events in the last decade, worldwide

MRI environment is safe when all precautions are taken, but can easily become dangerous if these are neglected. Recently, Delfino et al. published a report that summarizes the adverse events in the last decade (2008-2017). Here are the main findings:

During 2008-2017, the FDA has recorded 1548 worldwide MRI-related adverse events including 3 deaths directly associated with MRI:

  • Malfunction of an implantable pain pump after exposure to the static field of the MR system.
  • A field service engineer crushed by a blower panel that became a projectile.
  • A field service engineer who went into cardiac arrest while under anesthesia for follow-up treatment of a cryogen burn.

Other events included:

 

  1. Thermal events (906, 59%):
    From local irritations to 2nd and 3rd degree burns, some events were due to direct contact with the coil cables (16%) and scanner bore (10%).  Other major risks were skin-to-skin contact that caused RF loops (16%), and the existence of other conductive elements inside the bore (Jewelry & clothing, ECG or other electrodes, medical devices, etc. about 12%) summed to another 12%. Other events had either insufficient data to pinpoint the exact cause of burn (40%) or were unrelated to scanning (6% - e.g. fires or cryogenic events during maintenance). Only 6 cases of tattoo-related burns were recorded worldwide during these years. 
       
  2. Projectiles events (133, 9%)
    Projectiles can cause cuts and bruises and in extreme cases severe injuries and even death. Most projectiles were service carts, wheelchairs, monitors surgical tools & other patient-care equipment. Service tools & equipment (e.g. floor polishers, firefighting equipment) also became projectiles occasionally. In most cases human error or undrained personnel is the cause of projectiles event. In one example, a family member carrying a gun rushed to help the patient inside the magnet room. The gun went off and the bullet went inside his leg.
     
  3. Acoustics events (86, 6%)
    Most of the acoustics events were reports on ringing (tinnitus) or hearing loss prolonged exposure to scanner noise without adequate protection. In some cases, effects were reported even when protection was provided. Most likely protection was not applied properly or fitted poorly.
     
  4. Mechanical malfunctions (170, 11%)
    Mainly finger pinch from moving the patient table (sometimes requiring amputation of fingers), and falls from the table.
     
  5. Peripheral Nerve Stimulation (PNS)
    No adverse events were listed for PNS, and it is considered a patient comfort rather than a safety issue.

 

What can we do to avoid these hazards?

  1. Double-check ourselves every time we enter the MRI room. Never allow anyone who is untrained or is not required for the experiment to get near the MRI room door.
  2. Explain to the patient the importance of filling the metal screening form correctly. (Ideally, present the form to the patient beforehand, to avoid wasting their and your time).
  3. Place the patient carefully in the scanner. Make sure the fingers and hands are on the bed to avoid pinching. Instruct the patients to keep their hands and legs apart, and make sure there is no direct contact between them and the coil cables.
  4. Take your time when putting the headphones & earplugs properly, make sure that everything is in place and verify with the patients that they are comfortable.
  5. Encourage the patient to inform you immediately about any problem / burning / irregular sensation they are experiencing.
  6. Never enter any object to the MRI room that was not approved by ENU personnel beforehand.
  7. In emergencies, keep calm and follow the procedures. Do not let untrained personnel near the MRI room.
  8. If you are not sure about something, avoid doing it, and contact ENU personnel if necessary.